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A unique collaboration between two of the state's leading health care entities will bring another resource of high-level molecular testing to the Omaha market. This is the first tangible evidence of the Accountable Care Alliance at work since its formation in 2010.
The Nebraska Collaborative Laboratory (NCL) will initially perform high-level molecular testing for breast cancer, lung cancer and sarcomas. FISH (Fluorescence In Situ Hybridization) testing provides supplemental diagnostic information, based on a patient's tumor DNA, to determine the most effective course of treatment with the least amount of side effects.
According to Julia Bridge, M.D., medical director of the NCL and professor at the University Of Nebraska Medical Center, molecular FISH testing improves the quality of patient care while saving time and money. This is achieved by avoiding treatments that will not produce a desired result in an individual patient based on the presence or absence of a gene alteration in their tumor sample.
Conducting molecular FISH testing to predict which therapy a patient may or may not respond to reduces unnecessary negative side effects possibly associated with an ineffective treatment plan.
"The assessment of gene alterations by molecular approaches, such as FISH, has revolutionized the care of patients with specific types of cancers," Dr. Bridge said. "Increasingly, more cancer treatments are becoming available that are based on the genetic alterations or defects that are believed to cause that cancer to grow. To pinpoint these 'targeted therapies' that interfere with tumor growth and progression, the associated molecular target must first be identified in the patient's tumor sample."
This is where the NCL will come into play. For example, the examination for the presence of too many copies of a gene called ERBB2 (HER2) by FISH in the tumor cells of a patient with breast cancer is critical to selecting the appropriate medicine (HER2 targeted therapy) for that patient.
"Molecular characterization of many different cancer types by FISH also provides vital diagnostic information that is carefully integrated with traditional pathology for the most precise classification and guidance of treatment recommendations," Dr. Bridge said.
An internationally renowned subject expert, Dr. Bridge will oversee lab operations. Joining Dr. Bridge will be a group of experienced medical scientists in the field. The NCL will be located at The Pathology Center -- Schenken Pavilion on the Methodist Hospital Campus.
Representatives of Methodist Hospital and The Nebraska Medical Center visited similar labs across the country to determine its feasibility in Omaha. The group determined that by combining resources for efficiency, NCL would provide savings to both organizations through shared expenses.
"The NCL is an example of how independent organizations can work together on collaborative projects," said Glenn A. Fosdick, President and CEO, The Nebraska Medical Center. "As changes continue to take hold in the health care industry, we knew there would be price pressures on laboratories to reduce costs. So, we put the idea on the table and created teams of medical laboratory scientists and physicians to research it. Obviously, we found cost savings for the organizations and benefits for our patients."
Methodist Hospital and The Nebraska Medical Center administrators expect an enhanced level of service and better turn around times on test results by eliminating the delay of sending such test results out of state. They also expect to realize cost savings through efficiencies created by combining resources and through offering lab services to other health care facilities in the region.
The NCL will become not only a regional testing site, but a national resource for this type of testing. Future plans for the NCL will include expansion of sophisticated laboratory platforms while continuing to control costs.
Steve Goeser, President and CEO of Methodist Hospital, said the collaboration will generate efficiencies for both organizations.
"It did not make sense to take on this expense independently," Goeser said. "Together, through the Accountable Care Alliance, our organizations are improving the availability of these services to patients in Omaha while saving money through bigger discount pricing. Also, by electing to not send some tests out of state and use the combined volume to bring the testing in-house, we become even more efficient."
The Accountable Care Alliance builds upon a long-standing, mutually respectful relationship between the physicians of The Nebraska Medical Center and Methodist Health System. The ACA network will make it possible for The Nebraska Medical Center and Methodist Health System providers, collectively, to improve communications, reduce duplication of tests and procedures, and work together to improve the care experience of patients in the community.

Uncharted 4 A Thiefs End Gameplay Walkthrough on Crushing with All Collectibles & Stealth Lets Play Review Playthrough Part 1 2 3 4 5 6 7

Uncharted 4: A Thief's End is an action-adventure game played from a third-person perspective. It also includes elements commonly found in platform games. The player assumes control of Nathan Drake, who is physically adept and is able to jump, sprint, climb, swim, scale narrow ledges and wall-faces to get between points, swing with a rope, use a grappling hook and perform other acrobatic actions. Drake can use various firearms such as assault rifles, pistols and grenades to kill enemies. Stealth elements are incorporated into the game, allowing the player to sneak behind enemies and kill them without being noticed The melee combat system was reworked to avoid the presence of quick time events Drake also gains the ability of controlling vehicles directly.

While the game is linear, environments feature multiple paths for the player to explore. Maps are also significantly larger than the previous games in the franchise, with the explorable area being 10 times larger than the previous games. The artificial intelligence (AI) of enemies was enhanced. They are now able to respond to the player's actions more responsively, coordinate tactics, and cooperate with each other The AI of Drake's companions, including Sam and Sully, were improved and will assist Nathan in combat situations, though the player can not directly command them. A dialogue tree is introduced, though it does not affect the story's progression. The transition between cutscene and gameplay sequences has been described as "seamless". Extra visual filters and modes, such as a zero-gravity mode, bullet time gameplay, and a cel-shaded artstyle, can be unlocked by using points players collected in the main game.

Uncharted 4 Let's Play: https://www.youtube.com/playlist?list...

Uncharted: Drake's Fortune: https://www.youtube.com/playlist?list...
Uncharted 2: Among Thieves: https://www.youtube.com/playlist?list...
Uncharted 3: Drake's Deception: https://www.youtube.com/playlist?list...

Thanks to Sony for an Advanced Copy

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Carola de Moras está enferma y tuvo que quedarse en casa haciendo reposo luego que médicos que confirmaran que contrajo la bacteria.

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